Putting the patient first using a simulated peer clinical

coaching model

Rebecca McDiarmid

Donna Burkett

NZASH 2018

Simulation with first year students is centered

around clinical skill development

• Students are reluctant to embrace

simulation, feeling uneasy and awkward

when ‘taking to a dummy’

• It takes time for students to value the

learning of simulation

• Students tend to talk over the ‘patient’

instead of with the patient

• Simulation is initially low fidelity

Background Year 1 nursing students

Background Year 3 Nursing Students

• The healthcare workforce is evolving. There is

an increase in HCA and EN within clinical

environments. The role of the RN is adapting to

these changes.

• Year 3 students are entering the work force as

new graduates, feeling ill prepared for their

responsibilities directing and delegating care.

• As undergraduates, there is limited opportunity

to practice direction and delegation due to a

student nurse scope of practice.

Whilst considering the Year 1 and Year 3 learning experience, a literature

review relating to development of peer learning models and ways to enhance

development and transition of clinical skills was undertaken.

Clinical coaching modelHistorical teaching model

• Lecturer led and facilitated

• Skill focused

• Although teaching environment aims to

be inclusive and engaging, students can

be reluctant to participate

Supportive learning environment

Lecturer facilitated in collaboration with Year 3

Skill acquisition is situated with clinical focus

Role modelling effective patient communication and skill

integration in simulated scenarios

Continuing on from this experience there is increased

support network and peer learning during clinical

placement

The peer coaching model simulates the preceptor

relationship whilst having the dual benefit of

developing and enhancing clinical skill transition from

theory to practice for both Year 1 & Year 3 students.

Evaluation processSurvey of the Year 3 experience

Ethics approval gained from OP ethics

committee.

16 questions exploring experience, benefits,

ways to improve the clinical coaching

experience and transition theory into practice.

Informal feedback

Within the Year 3 transition to practice course,

there is an increased ability to articulate

direction and delegation (competency 1.3)

within the clinical portfolio.

Year 1 students have stated in course

feedback, one of the highlights in the clinical

skills course was working with the Year 3

students.

Informal debriefing post clinical coaching experience.

Student voice

“This experience helped the

first years develop what they

will know by third year, and it

can be aspirational”

“I have more belief in myself

that I am able to articulate

competency and educate

others”

“Prior to this experience I had

not delegated in clinical

practice, I had only

demonstrated knowledge.

With the clinical coaching

experience I mentored and

evaluated the skills of the 1st

year students” “I feel more confident”

“I was able to see the

importance of mentoring and

preceptorship and that one

day I will be able to do this in

practice”

Benefits of this experience:

Peer support

Safe learning

Collegial interaction –

connecting with colleagues

Clinical skill development

Sharing knowledge

Finding out more about the

journey in nursing

Seeing how to transition this

skill into clinical

Some survey resultsHow well do you think this experience has

prepared you for evaluating a colleagues

readiness to complete a task?

There were some challenges

Logistics of matching the Year 1 timetable with Year 3

Including geographical distance students within the learning

experience

Consistent approach for the process. Students rotated through labs

during the year with different skills taught during their experience

Simulation scenarios are a catalyst to considering

working relationships

Lab scenarios fostered collegial engagement in a

safe learning environment

Patient experience prioritized during clinical coaching

Where to next ……Developing this coaching progamme with EN, CAP, and stair case throughout the BN programme

Partnering ‘preceptoring’ training with DHB, PHO, NGO etc

Formally evaluate Year 1 experiences and consideration of optimal clinical skill development

Leadership in nursing

Peer supervision model

Streamlining simulation strategy within the school of nursing

References